Reviewed by Dr James R Bentham, Consultant Cardiologist
A patent foramen ovale (PFO) is a hole between the upper chambers of the heart (atria). This hole is a necessary part of the flow of blood for unborn babies when they are in the womb. The PFO typically closes shortly after birth due to changes in pressure in the heart chambers, but in approximately 25% of people this remains open or can open in certain circumstances allowing a small amount of blood to flow through it.
What is a PFO closure?
A PFO closure uses a small device that resembles two small umbrellas joined together and is positioned into the hole to close it up.
What are the benefits of a PFO closure?
For the majority of patients a PFO does not cause any specific symptoms. It is often found coincidentally as part of other medical investigations such as an echocardiogram. In some patients, a PFO allows a clot to pass from the lung to the body. This clot can then go onto cause a cerebrovascular accident (CVA) such as a stroke, a transient ischaemic attack (TIA) or affect another of the body's organs including the heart, limbs or gut. This happens when the clot blocks the blood vessel supplying a particular part of the body.
If the PFO is felt to be the likely cause of a clot getting into the body the benefits of a PFO closure include reducing the risk of a further stroke. Occasionally, PFO closure is considered to reduce decompression sickness in deep water scuba divers or if the PFO is allowing too much blue blood to pass through, which reduces the oxygen saturation levels.
How long do the benefits of treatment last?
The closure device will remain in position permanently. It would be unlikely that you will need further procedures to reposition, replace or remove the device; although there is a small risk of leaving a slight leak across the hole which may need further follow up with your cardiologist to monitor.
Is a PFO closure right for me?
If you have experienced a stroke, TIA or another form of ‘embolic’ event without a definitive cause and are found to have a PFO then a PFO closure may be right for you. It is a difficult decision and a consultation with a Cardiologist will help you decide whether you would benefit from PFO closure procedure.
Medical management with aspirin or a similar blood ‘thinner’ will usually be continued as well.
What happens during a PFO closure?
Before the procedure
You will likely be prescribed dual blood thinner medication (aspirin and clopidogrel) before you come in for the procedure and they should be taken as prescribed.
You will be given information by your consultant whether you need to stop taking any specific medications for the procedure, what you need to bring and whether you will be staying overnight.
During the procedure
A PFO Closure procedure occurs in a special treatment room called a catheter laboratory (Cath Lab) and is usually performed under general anaesthetic.
Firstly, you will put to sleep. Your consultant will then begin to assess the size of the PFO using a small ultrasound probe that is put down your throat called a trans-oesophageal echocardiogram (TOE). Once measurements have been taken and confirmed, a small tube called a catheter will be inserted into a large vein, usually in the right groin area. The catheter is then passed into your heart inside the vein in order that equipment such as wires and balloons can be used to cross the PFO.
A balloon is usually injected with special x-ray contrast at in order to visualise and measure the size of the PFO and compare it to the measurements obtained by the TOE. Once the correct size of closure device has been decided your consultant positions the device across the PFO and is guided by the continuing images from the TOE. The closure device can then be released and stays in position across the PFO whilst all the other equipment is removed from the access point in your groin.
A mechanical closure device can be stitched across to close the vein or the consultant will apply pressure to the wound to stop the bleeding.
The total time for the procedure is around 1 hour.
Recovery from PFO closure
After the procedure you will come round from the general anaesthetic in a recovery area where you will be monitored with an ECG, blood pressure and oxygen saturation. You will be lying flat for a short while to prevent bleeding from occurring in the groin area.
After a short while you will be transferred back to the ward where you can sit up and start mobilising. The majority of our PFO closure patients have an overnight stay and are sent for an echocardiogram in the morning to assess the device position and blood flow across the hole. All being well you will be discharged the day after the procedure.
You will need to continue to take aspirin and clopidogrel to thin your blood and stop large clots forming on the device. You will be advised how long to continue taking these for by your consultant.
In the first 24 hours after your procedure you should not
- drive a car or ride a bicycle
- operate machinery
- do anything requiring skill or judgement
- drink alcohol
- take sleeping tablets
- sign legal documents, make any important decisions, or sign contracts.
When you go home you should be back to full activity, including driving, after 3 days. If you have a physical job, we will advise you on when you can go back to work. You should avoid heavy lifting for 1 week.
Tips for managing your recovery at home
- Rest: having a procedure can be stressful and you should plan to take some time off work to recover faster
- Sexual activity: there are no concerns with continuing sexual activity as soon as the area where the procedure was performed feels comfortable
- Reaching/Household Chores: you should minimise reaching and chores for a couple of days to allow your body to recover
- Moving around and going up and down stairs: we will make sure you are stable and fully mobile before you go home
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